MEDICAL SECOND OPINION

Aortic Valve Problems and Treatment

Who is more likely to have aortic valve problems?

Aortic valve problems are generally seen in older ages. There are two types of diseases of the aortic valve. The first is the valve leakage towards the tube, which we call aortic regurgitation. Another is aortic stenosis.

In which cases are these closed treatments preferred instead of open surgery in aortic valve problems?

In the 1950s, the narrow valve was cut with open heart surgery, and a new valve was placed. Later, surgeries started to be done with tiny incisions. The patient's heart was stopped, the valve was removed, and surgery was performed in the style of inserting a new valve. Nowadays, a closed system is easily applied, especially in patients at risk for surgery, such as the elderly.

What is non-surgical aortic valve replacement TAVI?

TAVI is a procedure performed by entering the inguinal or arm vein, sometimes through the jugular vein, without opening the thorax. In short, it is placing a new valve into the narrow aortic valve by entering through a vein without needing open heart surgery.

Who is the appropriate Non-Surgical Heart Valve Replacement (TAVI) patient group?

TAVI should be applied primarily to all patients over a certain age who will be fitted with a biological valve, and surgery should be used for patients who cannot undergo TAVI. In particular, all patients over 60-65 should primarily prefer a natural valve. In these patients, open surgery should be considered if TAVI cannot be performed technically or anatomically.

What kind of anesthesia is used in Non-surgical Heart Valve Replacement (TAVI)? How long does the application take?

TAVI has been used around the world for ten years. In the first years, it was performed under general anesthesia. Afterward, it was started to be performed with local anesthesia and mild sedation. If all goes well, the process takes an average of one hour. The situation of each shapes the length of stay in the hospital influenced by each individual's situation. If the patient's general health is inconvenient, they can be kept in the intensive care unit for a few days. However, if everything goes well, they are kept for observation only for one day in the intensive care unit, one day in the service, and are discharged the next day.

When can the patient return to their social or business life after the procedure?

After discharge, the patient can quickly return to their social life because there is no general anesthesia and the rib cage is not opened. Since TAVI is performed with local anesthesia, the patient can go to the regular service the next day and walk around the service.
What should be considered, especially in terms of drug use after the operation?
These are biological valves obtained from bovine or pig pericardium. Therefore, they are compatible with the body. For this reason, drugs that seriously dilute the blood are not needed, but mild blood thinners are used for a while. They are taken as doubles for about six months. After six months, a drug such as baby aspirin is used for life.

What are the advantages of this method?

The most important advantage is that the patient's chest is unopened, and the heart is not stopped. In addition, the patient does not receive general anesthesia. When we look at the complications of surgery, especially when compared to surgery, kidney failure is less in these studies. Some rhythm disorders are also less in this process. The procedure time is shorter. Also, the length of stay in the intensive care unit is shorter. The patient quickly returns to everyday life. The durability of the biological valve is also a significant advantage. Studies of about 7-8 years were observed. According to these studies, there is no doubt that it is durable. However, it will be possible to say more when the studies going on over ten years are completed. In addition, a new valve can be inserted into this valve with a similar procedure.

Prof.
Engin BOZKURT, MD
Cardiology
Medicana International Ankara
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Created at 11.10.2023 06:20
Updated at 16.04.2024 09:08
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